Huang Po-Hao, Chen Chih-Wei, Hu Ming-Hsiao, Yang Shu-Hua, Huang Chuan-Ching
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Department of Orthopedic Surgery, National Taiwan University College of Medicine, Taipei, Taiwan.
Spine (Phila Pa 1976). 2025 Mar 1;50(5):339-346. doi: 10.1097/BRS.0000000000005085. Epub 2024 Jun 28.
A retrospective, single-center, observational study.
This study investigated the risk factors associated with the failure of conservative treatment for adjacent vertebral fractures (AVFs).
Adjacent vertebral fractures following vertebroplasty for osteoporotic vertebral compression fractures are not uncommon. Presently, there is a lack of consensus regarding the management of adjacent vertebral fractures.
We included patients who developed adjacent vertebral fractures within 2 years post single-level vertebroplasty between January 2013 and December 2020. All patients initially underwent 6 weeks of conservative treatment, including pain medications, bracing, and physical therapy. Surgical intervention was offered to those with intractable back pain due to AVFs. Baseline demographics, AVF characteristics, and radiologic measurements were systematically collected, and sequential univariable and multivariable logistic regression analyses were conducted to explore the risk factors.
Of the 114 patients with a mean age of 78.6 years, 2-thirds (76 patients) tolerated conservative treatment well, whereas 38 required surgical interventions for adjacent vertebral fractures. Both groups demonstrated similar baseline demographics and radiologic parameters regarding AVFs ( P >0.05). The multivariable logistic regression analyses revealed that the development of AVFs later than 6 months post-vertebroplasty and their caudal location to the index vertebroplasty were the independent risk factors of unsuccessful conservative treatment, with odds ratios of 3.57 (95% confidence interval [CI]: 1.14-11.1, P =0.029) and 2.50 (95% CI, 1.09-5.88, P =0.032), respectively.
Adjacent vertebral fractures following percutaneous vertebroplasty generally have favorable outcomes under conservative treatment. However, the timing and the relative anatomical location of adjacent vertebral fractures are associated with treatment efficacy. Adjacent vertebral fractures occurring later than 6 months following the initial vertebroplasty or situated in the caudal location to the index vertebroplasty may exhibit reduced responsiveness to conservative treatment. These patients might benefit from a more aggressive therapeutic approach.
一项回顾性、单中心观察性研究。
本研究调查了与相邻椎体骨折（AVF）保守治疗失败相关的危险因素。
骨质疏松性椎体压缩骨折椎体成形术后发生的相邻椎体骨折并不罕见。目前，对于相邻椎体骨折的治疗缺乏共识。
我们纳入了2013年1月至2020年12月间在单节段椎体成形术后2年内发生相邻椎体骨折的患者。所有患者最初均接受了为期6周的保守治疗，包括止痛药物、支具和物理治疗。对因AVF导致顽固性背痛的患者进行手术干预。系统收集基线人口统计学资料、AVF特征和影像学测量数据，并进行序贯单变量和多变量逻辑回归分析以探索危险因素。
在114例平均年龄为78.6岁的患者中，三分之二（76例）对保守治疗耐受良好，而38例因相邻椎体骨折需要手术干预。两组在AVF的基线人口统计学和影像学参数方面相似（P>0.05）。多变量逻辑回归分析显示，椎体成形术后6个月后发生的AVF及其相对于索引椎体成形术的尾侧位置是保守治疗失败的独立危险因素，比值比分别为3.57（95%置信区间[CI]：1.14 - 11.1，P = 0.029）和2.50（95%CI，1.09 - 5.88，P = 0.032）。
经皮椎体成形术后的相邻椎体骨折在保守治疗下通常有良好的预后。然而，相邻椎体骨折的发生时间和相对解剖位置与治疗效果相关。在初次椎体成形术后6个月后发生或位于索引椎体成形术尾侧位置的相邻椎体骨折可能对保守治疗的反应性降低。这些患者可能受益于更积极的治疗方法。
3级。
